Clostridium difficile (C.difficile) infection is the leading cause of hospital-acquired diarrhea and pseudomembranous colitis.C.difficile-associated disease (CDAD) is mediated mainly by two bacterial toxins, TcdA and TcdB, which cause the diarrhea, as well as colitis and even intestinal necrosis.It has been indicated that level of C.difficile toxin is an important factor influencing the clinical phenotype of CDAD, however, the exact association between toxin and clinical phenotype remains unclear.In this article, we summarized the clinical phenotype of CDAD, the structure, function and regulatory mechanism of C.difficile toxin and discussed the relationship between C.difficile toxin and clinical phenotype, which may help to understand the pathogenic mechanism and provide possible therapeutic target for C.difficile infection.

Clostridium difficile( C. difficile)is a major nosocomial infection pathogen and the principal causative agent of antibiotic-associated diarrhea. The toxigenic C. difficile strains cause colonic injury and inflammation mainly by secreting enterotoxin A( TcdA)and cytotoxin B( TcdB). The severity of C. difficile associated disease( CDAD)is correlated to the toxin level during host infection. However,the toxigenic capacity of C. difficile varies widely among strains,which correlates with the gene regulation involved during toxin production. This article reviewed the regulatory mechanism of C. difficile toxin-associated pathogenic gene and anti-toxin treatment.

Aim To investigate the effect of cobra venom metalloproteinase atrase A on human endothelial cell.Methods The effects of atrase A on the growth of HMEC were measured by MTT,SRB and morphological observation methods,respectively.After exposure to atrase A,IL-8,ICAM-1,MCP-1 and E-selectin released by HMEC were detected.Caspase-8 and caspase-3/7 were detected by fluorescent luminescence method.After intravenous injected atrase A to rats,the concentrations of ICAM-1,IL-8 and TNF-? in serum were measured.Results The results showed that atrase A(400,40 mg?L-1) significantly inhibited the growth of HMEC in low cell density.The microscopic examination revealed that atrase A detached the adherent HMEC.After exposure to atrase A,IL-8,ICAM-1 and MCP-1 released by HMEC were increased.Atrase A induced HMEC to express caspase-3/7 and caspase-8.After the administration of atrase A to rats,the concentrations of ICAM-1,IL-8 and TNF-? in serum were increased.There was no difference between the low-dose group and control group in our experiments.Conclusion Cobra venom metalloproteinase atrase A inhibits the growth of HMEC,and induces HMEC releasing inflammation mediators and apoptosis.

Objective To evaluate the clinical effect of acupuncture as an adjuvant therapy for acute pancreatitis (AP).Methods We retrieved the databases ofCNKI,VIP,Wanfang,PubMed,EMBase,and Cochrane Library,selected the relevant randomized clinical trials (RCTs) of AP treated with routine western medicine as control group and treated with routine western medicine combined with acupuncture therapy as trial group.And then,the quality of the qualified RCTs was evaluated,and the end-point outcomes of the RCTs were analyzed by Meta-analysis.Results A total of 7 RCTs involving 371 AP patients were included into the analysis.The time for abdominal pain relief(WMD =-1.44;95％CI:-2.38,-0.50),time for abdominal distension relief (WMD =-2.50;5％CI:-4.07,-0.73),time for the restart of anal exhaust(WMD =-1.79;95％CI:-3.73,-0.14),time for defecation (WMD =-1.95;95％CI:-3.51,-0.39),time for the restart of bowel sound(WMD =-1.39;95％CI:-2.44,-0.34),time for blood amylase becoming normal(WMD =-2.09;95％CI:-3.22,-0.96),and hospitalization time (WMD =-3.70;95％CI:-6.04,-1.36) in the trial group were less than those in the control group,and the differences of the above indexes except for the time for the restart of anal exhaust were significant (P ＜ 0.05).Conclusion Acupuncture as an adjuvant therapy is effective for improving the gastrointestinal function of AP patients,and shortening time for blood amylase becoming normal and hospitalization time.However,due to the low methodological quality,more well-designed randomized controlled trials are needed to confirm the therapeutic effect of acupuncture therapy for AP.

In this study,we collected the prescriptions of Professor Liu Fengbin used for the out-patients with irritable bowel syndrome(IBS),counted the usage frequency of the herbs and core-combination herbs in the prescriptions,analyzed the medication principles of Professor Liu Fengbin,and mined the new recipes for IBS by the methods of association rule mining and complex system entropy clustering presented in the Traditional Chinese Medicine Inheritance Support System.The results showed that Professor Liu is experienced in treating IBS based on liver-spleen differentiation,mainly applying the therapies of invigorating spleen and replenishing qi,soothing liver and regulating qi,also using the methods of resolving dampness,alleviating depression,relieving pain and activating blood,and prescribing the basic recipe of Chai Shao Sijunzi Decoction.The medication principles of Professor Liu Fengbin for the treatment of IBS will be beneficial to the further exploration of the syndrome pattern distribution of IBS and new recipes for IBS.

[Objective] To explore and analyze Professor ZHANG Yonghong's clinical experience in treating cerebral tumor.[Methods]Through the clinical study with the teacher to collect and collate the relevant information and medical records, from the etiology and pathogenesis of cerebral tumor, governance and other aspects of the specific analysis and discussion on Professor ZHANG Yonghong's treatment of this disease, academic point of view and clinical experience,it summed up the law of condemnation, and to the case of evidence,through regular follow-up, observing the treatment effect. [Results]Professor ZHANG Yonghong views that the pathogenesis of cerebral tumor can be summarized as Qi deficiency, phlegm and blood stasis, internal movement of the liver, and confusion of the body. Its pathologic factors are related to wind, fire, phlegm, blood stasis and poison. In the treatment of cerebral tumors, it is advocated to improve Qi, nourish Yin, promote positive Qi, and break loose to remove cancer toxins. On the basis of the selection of invigorating the spleen and protecting the stomach, the rational use of invigorating the Qi and nourishing the Yin and combining with the drugs of eliminating evils and removing toxin, in order to achieve the goal of strengthening the anti -cancer. The two cases both achieved good results by strengthening the body resistance, eliminating evils and removing toxin.[Conclusion]Professor ZHANG Yonghong stressed that strengthening of the body resistance is a primary treatment when the treatment for cerebral tumor. We should pay attention to replenishing Qi and nourishing Yin, eliminating evils and removing toxin are adjuvant therapy. The spleen and stomach should be protected throughout the treatment, and patient's mood are also important. It is of great significance to instruct TCM to treat cerebral tumor.

OBJECTIVETo study diterpenoid alkaloids from the roots of Aconitum recemulosum, and their inhibitory effects on PAF-induced platelet aggregation.

METHODThe root of A. recemulosum was extracted with 95% EtOH. The total alkaloids extracted were isolated and purified by several kinds of column chromatography over silica gel, RP-18, and Sephadex LH-20, and identified based on spectral analysis. And the inhibitory effects of isolated compounds on PAF-induced platelet aggregation were detected.

RESULTFive alkaloids were isolated and identified as sachaconitine (1), 14-acetylsachaconitine (2), hemsleyanine C (3), circinasine A (4), and talatisamine (5). The results showed compounds 1 and 2 have moderate inhibition effect on PAF.

CONCLUSIONCompounds 1-5 were firstly isolated from this plant. Furthermore, compounds 1 and 2 possessed moderate inhibitory effects on PAF-induced platelet aggregation.

Aconitum ; chemistry ; Alkaloids ; chemistry ; isolation & purification ; pharmacology ; Coagulants ; pharmacology ; Diterpenes ; chemistry ; isolation & purification ; pharmacology ; Humans ; Plant Extracts ; chemistry ; isolation & purification ; pharmacology ; Plant Roots ; chemistry ; Platelet Aggregation ; drug effects

Objective:Objectives To investigate the predictive value of color Doppler flow imaging (CDFI) for the proteinuria following pyeloplasty for congenital ureteropelvic junction obstruction (UPJO) in children.Methods:We identified a series of 206 children with a mean age of (20.0±28.8) months (1-132 months), consisted of 171 males and 35 females, diagnosed with congenital UPJO accepted pyeloplasty from January 2014 to September 2018, the preoperative mean urinary Albumin/Creatinine Ratio (ACR) was (17.3±160.1) mg/mmol and the mean β2-microglobulin/Creatinine Ratio (β2-MG/Cr) was (135.6±383.8) μg/mmol, ultrasound showed a mean renal pelvis dilatation of (3.1±1.5) cm and a mean cortical thickness of (0.3±0.1) cm, and classified as grade Ⅰ-Ⅴ according to the blood flow distribution in renal by CDFI, these children were divided into three groups of increased, decreased and unchanged blood flow according to the postoperative CDFI within 1 week, the postoperative urinary protein and renal function indexes within 1 week and 2 years were retrospectively analysed among groups.Results:Within 1 week postoperatively, an increased, decreased and unchanged blood flow occurred in 113 (54.9%), 31(15.0%), 62(30.1%) children, respectively. Urinary ACR in above mentioned groups was (112.3±400.7), (16.1±29.3), (32.7±48.4) mg/mmol, β2-MG/Cr was (887.4±6061.0), (50.2±62.7), (51.9±57.8)μg/mmol, there were significant differences among groups ( P<0.01). Contralateral hydronephrosis occurred in 21(18.6%), 4(12.9%), 8(12.9%) children, urinary N-Acetyl-β-D-glucosaminidase (NAG) was (7.5±5.2), (7.0±5.4)、(5.7±4.5) U/L, these indexes showed no significant differences among groups. There was a positive correlation between the increased blood flow level and the decreased renal pelvis dilatation (Spearman’s correlation coefficient 0.2, P<0.01), ACR (Spearman’s correlation coefficient 0.4, P<0.01) and β2-MG/Cr (Spearman’s correlation coefficient 0.3, P<0.01). After a follow up of 2 years, 67 children were diagnosed with proteinuria in this series, 51 cases of them with an increased blood flow, which had significantly higher percentage than children with a decreased (4 cases, 12.9%) or unchanged blood flow (12 cases, 19.3%). Logistic multivariate analysis indicated that early postoperative (within 1 week) increased blood flow ( OR=1.9, 95% CI 1.5-2.6), contralateral hydronephrosis ( OR=2.2, 95% CI 1.1-4.8) and urinary NAG ( OR=1.1, 95% CI 1.0-1.1) were predictive of proteinuria, the increased blood flow was independent predictor of proteinuria (Ⅰ level increased: OR=1.9, 95% CI 1.5-2.6). Conclusions:The CDFI reveals good predictive value for the postoperative proteinuria, an early marked increased blood flow postoperatively indicated risk of proteinuria in the long term.